Restructuring an internal medicine residency program to meet regional and national needs for general internists

Practice preferences of primary medical care and traditional internal medicine house officers

“…Although the basic knowledge and skills needed to provide competent medical care are similar for both primary care and traditional internal medicine house officers, primary care programmes have given more emphasis to education in ambulatory care, continuous care, non‐internal medicine specialties and the psychosocial aspects of illness and health; in contrast, traditional internal medicine residency training has tended to focus on in‐patient subspecialty treatment of the seriously and (usually) acutely ill (Goroll et al 1975; Perlman et al 1976; Eisenberg 1980; Wartman et al 1980; Petrusa et al 1983; Grol et al 1985). Furthermore, it has been shown that the educational setting of a training programme can have a major influence on the career goals and medical practice activity preferences of trainees (Marienfield 1977; Petersdorf 1978; Goldenberg et al 1979; Crain et al 1981; Dale et al 1981; Weil & Schleiter 1981). If departments of internal medicine in academic medical centres are to train primary care doctors, care must be taken to ensure that house officers who enter these programmes with a desire to practise general internal medicine are not diverted from their goals (Boufford 1977; Petersdorf 1978; Wartman et al 1980).…”

“…There are several factors responsible for this shift: a shortage of primary care doctors (Petersdorf 1978; Geyman 1986); the evidence that general internists spend over half of their time in out‐patient encounters (Reitemeier et al 1975; Mendenhall et al 1979); changes in the financing of medical care (Perkoff 1986; Schroeder et al 1986); and changes in the utilization of hospital and ambulatory services (Perkoff 1976). At many academic medical centres in the United States, one response has been the development of primary care internal medicine training programmes (Goroll et al 1975; Liang et al 1976; Perlman et al 1976; Boufford 1977; Peaslee & Sarosi 1978; Mendenhall et al 1979; Goodson et al 1980, 1986; Dale et al 1981; Kurtz 1982).…”

Use of Private Offices in Education of Residents in Internal Medicine

“…The resident-preceptor questionnaires requested information in the following categories: (1) demographic data, (2) selection proc¬ ess for the office assignment, (3) educational activities of the assignment, (4) This survey found that office practice assignments are offered by only 7% of the accredited internal medicine residency programs in the United States. Our sample size is small, as only 22% of programs offering such assignments responded with the full information we requested.…”